Orthognathic Hardware Complications In The Era Of Patient-Specific Implants
Christopher L. Kalmar, MD MBA, Laura S. Humphries, MD, Carrie E. Zimmerman, BS, Giap H. Vu, BS, Jordan W. Swanson, MD, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: Patients undergoing orthognathic skeletal correction present with a variety of comorbidities that may affect surgical outcomes. Additionally, advances in technology such as patient-specific implants may also affect results. The purpose of this study is to understand how patient risk factors and operative technique affect complication rates after orthognathic surgery in the era of patient-specific implants.
METHODS: Retrospective cohort analysis was conducted of all patients undergoing orthognathic surgery from 2014-2018. Patient risk factors, operative characteristics, and postoperative outcomes were gathered and compared with appropriate statistics.
RESULTS: Ninety-six patients met inclusion criteria with an overall one-year complication rate of 10.4% (n=10). Craniofacial syndromic status was significantly associated with any postoperative complication (p=.041, OR=4.065), infection (p=.005, OR=1.152), and readmission (p=.035, OR=5.156) due to hardware-related problems. In univariate regression, patient-specific mandibular plates were significantly associated with readmission (p<.001, OR=34.800), reoperation (p<.001, OR=24.167), infection (p=.004, OR=10.875), and hardware exposure within a year of surgery (p=.012, OR=13.111) in patients with a craniofacial syndrome or history of cleft lip or palate. In multivariate regression, patient-specific mandibular plates continued to show significant association with readmission (p<.001), reoperation (p<.001), infection (p<.001), hardware exposure (p<.001), and nonunion (p=.001) while controlling for syndromic status.
CONCLUSION: In the era of patient-specific orthognathic surgery, syndromic status and use of patient-specific mandibular plates are associated with increased complications, readmission, and reoperation. Future prospective study may elucidate pathophysiological mechanisms behind these findings.
Back to 2020 Posters
